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Mutuelle for a disabled young person ?


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I have a daughter, who has severe learning difficulties (brain damage since birth).  She is registered as handicappe in France and has 100% health cover (Affection Longe Duree) until 2016.    Up to now, she has been included in our family's mutuelle but she is just about to be 20 years old and so needs her own paperwork.

Does she need a mutuelle?  She has been in and out of hospital but this is covered by ALD because her illnesses are associated with her brain damage.  What would not be covered by ALD?

I would be most grateful of someone could enlighten me because I am in fog about this.  I am not sure where to find out other than this Forum.  I did telephone an insurance agent but they could not tell me.

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[quote user="Kitty"]

 Does she need a mutuelle?  She has been in and out of hospital but this is covered by ALD because her illnesses are associated with her brain damage.  What would not be covered by ALD?

[/quote]

Normally, any treatment which is not associated with her ALD would not be covered.  For example, if she accidentally tripped over the cat and injured herself, then that would likely not be covered. 

Now that she is an enfant majeur, you might want to consider speaking with your local assistant sociale to see if there are any adult benefits that she may now be entitled to.

 

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My son is also disabled and had all the disability allocations as a dependent child  up to the age of 20. Once he passed his 20th birthday he moved into adult services, which included a new application to the Maison des Handicapés and he moved to adult disablity benefit 'Allocation d'Adultes Handicapé' AAH. Once this happened, he was no longer able to receive his health care as my dependent with CPAM  (I have cover via employment), but was given his own SS number and health care in his own right - which is automatic for anyone receiving AAH. Once this happened, he could no longer stay under my Mutuelle cover, but had to have his own independent account with them. Personally, I would never choose to be without the top-up insurance, even with ALD recognition as other things can happen and I am a bit of a worrier.  None of this process was terribly complicated as my son was already known to services, but it did involve a lot of paperwork and a bit of attention to detail. Happily for us, my son is now working and, whilst he still gets the means tested part of his AAH, his health cover is thanks to his employment - and he has kept the same mutuelle (Santévie, which is local and seems very reasonable).

To  be a bit more specific about what would not be covered by the ALD - anything that is not the ALD - so, worst case scenarios in my mind are acute life threatening illnesses which would involve complex interventions and might not classify as ALD in their own right - viral encephalitis or meningitis involving intensive care, serious accident, ruptured appendix with peritonitis, things along those lines. Other things - such as dental work, minor illnesses and accidents would incur expense, but not of the kind that could bankrupt you.

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Thank you all for your prompt and helpful replies.  She is already registered with the Maison des Personnes Handicappes (MDPH) so I shall pop along there to ask what her number is and ask about ACS.  I did go to CPAM but they said that because she is handicappe, she has to remain with my provider, RSI.  Two of my other children who are coming of age have had to move over to CPAM.  Complicated or what?

Based on your replies, I reckon that I shall get a mutuelle for peace of mind.

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